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~~ <br />D - R//ECEIVED <br />~NOV 2 8 2005 <br />ANNTJAT. FF,F, and REPORT RF.nTTFST yy}}~ <br />rVa1V1$ILh al, <br />~j/~ ,.,ba., n,Ji..a:cya <br />PERMITTEE NAME: 1 1'Gloffat County <br />PERMIT NO.: 989-112 <br />l~Jpv <br />OPERATION NAME: Refuge Pit #1 ~ 4 <br />ANNIVERSARY DATE: December 8, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />_! operator shall submit the annual fe~,_a~report and man shpwing the~ctent of current distur~iances to affe_ct~d_ _ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal re~nrt and anmial re~nrt main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Billy E. Mack <br />Permittee Name: Moffat County <br />Address: P.O. Box 667 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-3211 <br />(970)824-0356 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Stockpile reduction only - no map necessary. <br />Q - ~~~ <br />Signature~Corporate Officer, Owner, or Designee <br />November 9, 2005 <br />Date <br /> <br />M:~PERMI7IMASTERCpCUMENTSNr-AF-04 <br />